A new version of the standard health insurance contract came into effect 1 March. The new standard contracted, known as SHIC, forms the base for all other health insurance plans.
The changes to the SHIC plan include higher premiums but also additional benefits.
Also starting 1 March, insurance policy holders began seeing an increase of at least $5 on their current contracts to help offset some of government’s spending on healthcare for people without healthcare coverage.
Those contributions will be added to the Segregated Medical Fund, which helps pay for indigents’ medical bills. The contribution for indigent care is doubling from $5 to $10 for individual plans and from $10 to $20 for family plans.
The government spends about $20 million per year on indigent care, representing about 22 per cent of the government’s spending on healthcare costs. The increased contributions should double the amount of funds the Health Insurance Commission collects for indigent care, to about $5 million a year.
Under the existing regulations, the SHIC contract covers only $25,000 per episode of illness, a stipulation which has been removed in the revised version. The new version retains benefits of $100,000 per year in medical fees and $1 million during the lifetime of the policy.
The amended SHIC plan will cover 80 per cent of $400 for doctor office visits, radiology and laboratory work for diagnostics and physiotherapy with physician referral, compared to the current benefit is just $100 per year for those services.
The new SHIC plan will also cover wellness benefits, including routine physicals, annual exams, nutrition counselling and one dental examination, up to 80 per cent of $200 per year. There was no provision for wellness benefits is the previous plan.
Other items that are covered include 80 per cent to the coinsurance maximum and thereafter 100 per cent up to $25,000 per lifetime for inpatient mental health care and 100 per cent of the first $4,000 outpatient services for emergency medical care, including medication and ambulance provision, and then as per applicable benefit category. Air ambulance use is also fully covered up to $15,000 per annum, based on medical necessity.
While the government regulates the SHIC plans, it does not regulate other plans offered by insurance companies. However, the changes to SHIC may also lead to a rise in the cost of premiums for people on more expensive and extensive plans.